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Middlesbrough Joint Health and Wellbeing Strategy

2012 - 2022

Authors Version Date Audience

Kathryn Warnock / Becky James

2 September 2012 Public Document

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Contents

Section 1 1

Section 2

Section 3

2

3

Section 4

Section 5

Section 6

Section 7

Section 8

Section 9

Section 10

4

5

6

7

9

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10

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Foreword

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Middlesbrough’s first Joint Health and Well Being Strategy sets out the long-term vision of the Middlesbrough Health and Well Being Board and sets out how the board, through collaborative working will respond to priorities identified in the Joint Strategic Needs Assessment.

In order to make a real tangible impact, the Board has agreed four themes to provide a framework for how it will respond to the major challenges it faces and deliver this vision. In particular it will focus on where it can add value to existing work across partner agencies and initiate a step change in the way things are delivered at the local level.

At the heart of the strategy will be the needs and views of the local population which is why we have carried out a range of consultation to ensure people’s views have been fed into the planning process.

Ray MallonChair of Middlesbrough Health & Well Being Board

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Middlesbrough Joint Health & Well Being Strategy: Emerging Framework

Vision Improve the health and well being of our local population and reduce health inequalities

Ensure children and young people have the best health

and well being

Invest in robust early help with a

focus on the family Support emotional health and well

being of young people and their families

Improve maternal health and early years health and well being outcomes

Multi-agency approach to improving

lifestyle choices Increasing uptake of preventative

and early intervention programmes Improving emotional health and well

being across the life course

Reduce variation in the management of patients with long term conditions

Integrate health and social care services for people with long term conditions

Deliver the right care, right time, right place Care closer to home Support independence, reablement,

designing care around the patient Deliver of sustainable services

Influencing

social causes

Working better in

partnership

Leadership & Advocacy

Strategic focus on prevention &

early help

Whole system approach

Targeted Approach

Community Engagement

Aims Reducing preventable illness

and early deaths

Ensure high quality, sustainable and joined up health, social care

and well being services

Priorities

Ensure a Healthy standard of living for all Maximise people’s

income Improve housing

options

Create and develop healthy and sustainable places and communities Reduce crime and anti-social

behaviour Maintain streets and open

spaces Integrate planning, transport

housing, environmental health systems to address health inequalities

Raise aspirations and educational attainment

Reduce inequalities in education and skills

Improve access and use of quality life-long learning

Create fair employment and good work for all

Improve access to good quality sustainable jobs

Reduce Unemployment – especially youth

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Introduction

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What is the Joint Health and Well Being Strategy?

The Joint Health and Well Being Strategy provides the overarching vision and strategic framework for improving health and well being and tackling health inequalities in Middlesbrough.

The Strategy is underpinned by a number of national and local policies, strategies and action plans.

Some of the priorities highlighted in the strategy will require long term action at a generational level to make lasting and sustainable change to the health challenges faced in Middlesbrough today, whereas others need to be addressed in the short-term with actions to improve and integrate health and social care services.

Contributions from a whole range of stakeholder and the the local community has helped shap the strategy, a detailed report setting out the consultation and engagement process and their findings can be found at( include link).

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National policy context Health and social care act The Health and Social Care Act 2012 places health and wellbeing boards at the centre of planning to transform health and social care and achieve better population health and wellbeing. Health and wellbeing boards have been given a number of core responsibilities including assessing the health and wellbeing needs of the local population through the joint strategic needs assessment (JSNA) and preparing a health and wellbeing strategy. This strengthened role of JSNAs and joint health and wellbeing strategies will enable Local Councillors, local Healthwatch, clinical commissioning groups, NHS commissioning board, Directors of Public Health, Adult and Children’s services to work with their communities in leading a more effective and responsive local health and care system.

Liberating the NHS In 2010 the coalition government published its proposal for radical reform of the NHS. The reforms include the abolition of primary care trusts and strategic health authorities and the creation of a national commissioning board, clinical commissioning groups, a national public health service – Public Health England - and transferring public health functions to local authorities. Local government and local communities will be at the heart of improving health and wellbeing for their populations through the establishment of local health and wellbeing boards, local and national Healthwatch organisations.

Healthy Lives, Healthy People - Public health White paper The public health white paper sets out the Government’s long-term vision for the future of public health in England to strengthen both national and local public health action. The goal is to establish a public health service that improves health and wellbeing, reduces health inequality and ensures local populations are protected from harms to health. The transfer of public health from primary care trusts into local government provides an opportunity to address the social causes of poor health and wellbeing such as housing, education, employment, transport, regeneration, environment and leisure.

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National policy context Marmot review

Sir Michael Marmot’s review states that health inequalities arise from a complex interaction of many factors such as housing, income, education, social isolation, disability – all of which are strongly affected by one’s economic and social status.

The Marmot review made the following six key policy objectives which have been used in developing the Middlesbrough health and wellbeing strategy:

– Give every child the best start in life– Enable all children young people and adults to maximise their capabilities and have control over their lives– Create fair employment and good work for all– Ensure healthy standard of living for all– Create and develop healthy and sustainable places and communities– Strengthen the role and impact of ill health prevention

Caring for our Future: Reforming Care and Support – Department of Health White Paper

‘Caring for our future: reforming care and support’, sets out the vision for a reformed care and support system.

This vision for reformed care has informed the Middlesbrough health and wellbeing strategy, will:– focus on people’s wellbeing and support them to stay independent for as long as possible– introduce greater national consistency in access to care and support– provide better information to help people make choices about their care– give people more control over their care– improve support for carers– improve the quality of care and support– improve integration of different services

Children and young people

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Developing the Joint Health and Well Being Strategy

A number of key local documents were used to create the evidence base for the strategy, which all contribute to improving health and well being.

It is recognised that the health and well being strategy can not realistically cover all the issues that contribute to good health and well being. In compiling this document, the Health and Well Being Board have sought to identify areas where it can add value and avoid duplication with actions covered in existing plans and strategies.

The strategy is intended to set the context for other health and well being plans that already exist across the different agencies, as well as providing a framework for monitoring the implementation of these strategies. The Health and Well Being Board will work with all partners to align plans, policies and resources with the strategy enabling joined up multi-agency action to tackling the key health challenges Middlesbrough currently faces.

The different plans and strategies that support the Health and wellbeing strategy are listed in Appendix 1 and grouped under the themes of the JSNA.

Local policy context

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The role of the Health & Well Being Board

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The Health and Well Being BoardMiddlesbrough Health and Well Being Board is responsible for promoting integration and partnership working between the NHS, social care, public health and other local services. A number of key organisations are represented on the Board and its supporting Executive.

What the board will doTo ensure that the strategy is being implemented across the health and well-being system the board will: •Oversee the production of a Joint Strategic Needs Assessment•Develop and lead the implementation of the health and well being strategy•Develop an annual work programme for addressing the priorities identified in the health and well being strategy• Review commissioning intentions (and service plans) for adult social care, public health, children and young people’s services, the clinical commissioning group and the NHS Commissioning Board to ensure alignment with the JSNA and the health and well being strategy•Seek assurance from commissioners and providers that NHS, public health , social care and related children’s services are safe, high quality and delivering to a high standard

•Work with partners to align current and future strategies, plans and policies and resources enabling joined up multi-agency action to improving health and well-being •Influence partner agencies and strategic forums to ensure social causes of poor health and well being are being addressed.

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Behaviours of the Health & Well Being Board

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         Ability to build and retain trust; Act with integrity; Accept criticism; Active; Astute; Attention to detail; Creative; Critical approach; Challenging; Collaborative; Commitment to ongoing training and learning; Common sense; Confident; Confidentiality; Credible; Diplomatic; Empathic; Energetic; Flexible with the ability to adapt; Focus on the positives; Forward looking; Friendly; Holistic; Honest; Impartial; Independent; Informed; Motivated; Non-judgemental; Objective; Open minded; Patient; Professional; Quality focussed; Realistic and not overly raise expectations; Respect the differences of diverse communities; Reflective; Responsible; Supportive; Systematic; Transparent; Trustworthy; Use evidence, don’t make assumptions; Value the commitment of volunteers.

Ability to build and retain trust; Act with integrity; Accept criticism; Active; Astute;

Attention to detail; Creative; Critical approach; Challenging; Collaborative;

Commitment to ongoing training and learning; Common sense; Confident;

Confidentiality; Credible; Diplomatic; Empathic; Energetic; Flexible with the ability to

adapt; Focus on the positives; Forward looking; Friendly; Holistic; Honest; Impartial;

Independent; Informed; Motivated; Non-judgemental; Objective; Open minded;

Patient; Professional; Quality focussed; Realistic and not overly raise expectations;

Respect the differences of diverse communities; Reflective; Responsible; Supportive;

Systematic; Transparent; Trustworthy; Use evidence, don’t make assumptions; Value

the commitment of volunteers.

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Middlesbrough Health & Well Being Board – Governance Structure

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Middlesbrough – The Current Health Picture

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•Population figures •Life expectancy at birth remains lower than regional and national averages. The life expectancy

gap in Middlesbrough between the most deprived and least deprived wards is widening and estimated at 14.8 years for males and 11.3 years for females (compared to 12.4 years for males and 9.5 years for females between 2001 and 2005)

•It is estimated that for every mile down Ormesby Bank, there is a two year reduction in life expectancy

•Health outcomes for children and young people remain a challenge with some indicators falling within the bottom quartile nationally

The Statistics

Not all bad news….•Middlesbrough has continued to make progress in improving health outcomes for the local

population over recent years•Deaths from cardiovascular diseases have fallen faster in Middlesbrough compared to England,

falling by 66% between 1995 and 2010•Latest figures (2008 – 2010) show that Middlesbrough’s male and female life expectancy at birth

continues to improve and is currently 76.1 years and 80.2 years respectively

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Middlesbrough – The Current Health Picture

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The Challenge

Middlesbrough includes areas which range from deprived to affluent. They lead to very different life chances and to very different health outcomes. Health inequalities are driven by a complex interaction of factors:

•Social factors such as poverty, deprivation, unemployment, poor housing, crime, poor educational attainment are the underlying causes of poor health outcomes•Lifestyle and behavioural factors such as smoking, binge drinking, lack of physical activity and poor nutrition, all major contributors to the leading causes of preventable illnesses and premature deaths•Poor uptake of preventative services such as screening, immunisation and early diagnosis programmes, reliance on emergency services and urgent care coupled with delayed presentation to health services

In order to improve the health and well being of the local population, coordinated action is required between the different agencies whose services are aimed at tackling aspects of this complex jigsaw. A detailed description of the interaction of these factors is covered in the JSNA and the JSNA summary documents available on http://www.teesjsna.org.uk/middlesbrough

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The Vision

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“Improve the health and well being of our local population and reduce health inequalities”

The vision for the Middlesbrough Joint Health and Well Being Strategy is that by 2022, in Middlesbrough:

• More children and young people will lead healthy safe lives and achieve their full potential

• Less people will be dying prematurely from preventable causes

• More people will be living longer and healthier lives

• People will receive the right services, at the right time, in the right place

• There will be less people experiencing social deprivation

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Strategic Aims

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1 - Ensure children and young people have the best health and well being

2 – Reduce preventable ill-health and early deaths

3 – Ensure high quality, sustainable and joined up health, social care and well being services

4 - Tackle social causes of poor health and well being

Through consultation with key partners and reflecting on the findings of the Joint Strategic Needs Assessment, the Health and Well Being Board have identified four themes as the focus of

the Joint Health and Well Being Strategy:

These themes will form the basis of the board’s annual work programme and focus on implementing actions and ways of working, over and above existing activity under each of these

themes.

The next section of the strategy will look at these themes in more detail including the current picture, strategic priorities for the Board to focus on, and high level outcomes.

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Ensure children and young people have the best health and well beingThere is increasing evidence to show investment in the early years of life (0-5) is highly effective in terms of future impact on health and well being, from obesity and mental health to educational achievement and

economic status. Children and families need appropriate support and preventative services during pregnancy and early years to ensure all children have the best start in life.

Invest in robust early help with a focus on the family

Support emotional health and well being of young people and their families

Improve maternal health and early years health and well being outcomes

•Childhood obesity rates more than double between reception and Year 6

•Teenage pregnancy rates are higher than regional and national averages

•Number of children living in unemployed / low income families is increasing

•Levels of educational attainment are generally poor, particularly around language and literacy

•Number of young people not in education employment or training (NEET) is above average

The current picture – what the JSNA tells us:

•Health outcomes for babies remain in the bottom quartile nationally – key indicators include smoking during pregnancy, low birth weight, breastfeeding

•Children’s oral health is very poor compared to the national average

•Chaotic and dysfunctional families are causing excessive pressure on health, social care and children’s services

AIM

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Reduce preventable illness and early deathsSmoking, unhealthy nutrition, physical inactivity and alcohol consumption have a profound impact on the

physical and mental health and well being of people in Middlesbrough. In order to reduce illness and early deaths, we need to ensure people and communities are supported to take responsibility for their own health.

Taking action through prevention, education and improved health care will result in reduced costs for the health and social care system now and in the future.

Multi-agency approach to improve behavioural and lifestyle risk factors (physical activity, nutrition, alcohol, smoking and sexual health)

Increase uptake of preventative and early intervention programmes, especially in high risk groups

Improve emotional health and well being across the life course

•Smoking remains the single preventable cause of premature deaths locally

•Adult obesity rates in Middlesbrough are higher than regional and national averages

•Binge drinking and alcohol related harm to individuals, families and communities are higher than regional and national averages

•Alcohol related hospital admissions are the fourth highest in the country

What the JSNA tells us:

•Cardio-vascular, cancer and respiratory disease are the largest contributors to premature death

•Emergency admission rates remain higher than national average and mirror patterns of deprivation across the town

•There are a significant number of people with undiagnosed long term conditions

•Uptake of screening programmes is lower for people from deprived areas across the town

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Ensure high quality, sustainable and joined up health, social care and well being services

It is anticipated that by 2030, in Middlesbrough there will be a significantly increased number of older people and an increase in the number of people living with long-term conditions. This will inevitably have an impact

on local health and social care services. Addressing this will require well-integrated health and social care systems to provide effective and suitable treatment and support.

Reduce demand on emergency and urgent care services

Deliver the right care, at the right time, in the right place – especially for people with long-term conditions

Improve outcomes for people with long term physical and mental health conditions

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What the JSNA tells us:

•There is increasing reliance on emergency and urgent care services

• High emergency admissions and attendances at Accident & Emergency which mirror the pattern of deprivation across the town

• Variations in the quality outcomes framework indicators for management of patients with long term conditions across GP practices in Middlesbrough

•75% of people aged over 65 known to social care have a disability

•There are increasing numbers of people with long term and mental health conditions associated with an ageing population

•There are gaps in the rehabilitation and recovery pathway for people with severe and complex conditions•Chaotic and dysfunctional families are causing excessive pressure on health, social care and children’s services

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Tackle social causes of poor health and well being

Ensure a healthy standard of living for all Raise aspirations and educational attainment

Create and develop healthy and sustainable places and communities

Create fair employment and good work for all

There is clear evidence that the environments in which people live (the economic, social and natural environments) have the greatest impact on achieving health and well being.

The Health and Well Being Strategy is underpinned by the Marmot principles to improving health and well being outcomes and the Health and Well Being Board will have a key role in ensuring these principles underpin the work of partner organisations to influence the wider determinants of health.

•The number of fuel poor households is increasing and homes in disrepair are occupied by some of the most vulnerable households

•Worklessness remains a major challenge with unemployment rates above average

•There are high levels of youth unemployment

What the JSNA tells us:

•There has been an increase in the risk to health and well being due to the economic downturn and welfare reforms

•Levels of educational attainment are generally poor

•There are high benefit rates across the town

•Domestic violence remains a significant issue with reported levels double the national average

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Ensure a Healthy standard of living for

allMaximise people’s incomeImprove housing standards

Create and develop healthy and sustainable places and communities

Reduce crime and anti-social behaviourMaintain streets and open spacesIntegrate planning, transport housing, environmental health systems to address health inequalities

Raise aspirations and educational attainmentReduce inequalities in education and skillsImprove access and use of quality life-long learning

Create fair employment and good work for all

Improve access to good quality sustainable jobs Reduce Unemployment – especially youth

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Working better in partnership

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Leadership & AdvocacyMake health and well being everyone’s business through cross sector capacity building

Promote key health messages by strategic influence, advocacy and PREmbed equality and equity in all policies

Strategic focus on prevention and early helpEncourage a resource shift towards early prevention and intervention

Family centred approaches and interventions

Whole System Approach Achieve the best outcomes for Middlesbrough in an efficient and sustainable way

Commission and deliver high quality, safe and integrated health and well being services Not commission or deliver services in a way which has an adverse impact on partner organisations without

agreement Strategic planning for future demands on health and well being services

Targeted ApproachAppropriate, systematic, coordinated and targeted interventions to improve the health and well being of the

poorest and disadvantaged groups fastest

Community EngagementEngage with local communities, patients, service users, carers and the public in commissioning and delivery

of health and well being servicesEmpowering and enabling communities and individuals to take responsibility for their own health and well

being

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Implementing, Monitoring & Reviewing the Strategy

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Middlesbrough Health and Wellbeing Board will ensure that the Strategy is effectively implemented by establishing appropriate governance mechanisms to deliver the strategy this will include members of the Board championing and raising the profile for key issues such as avoidable costs, giving children the best start in life and teenage pregnancies.

It is important that the strategy remains outcomes-focussed and that these are appropriately measured to ensure progress is being made and we are starting to make a difference.

Progress against the strategic priorities will be monitored through key performance indicators and targets drawn from the national outcomes frameworks and where applicable locally determined indicators. Regular performance reports will be presented to the health and well-being board. An annual work programme will be developed will run alongside the strategy which will identify the key actions to be undertaken

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Outcome Frameworks

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Protect the population’s health

Tackle wider determinants of health

Promote healthy lifestyles

Reduce preventable ill health

Prevent premature death

Public Health Outcomes

NHS Outcomes Adult Social Care Outcomes

Enhanced quality of life for people with care

needs

Positive experience of care

Improved recovery from illness and injury

Improved safety and protection from avoidable harm

Delay / reduce need for care

Protect from avoidable harm

Children and Young People Outcomes

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APPENDIX 1: Links with alternative strategies

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APPENDIX 1: Links with alternative strategies

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APPENDIX 2: Current Strategy timescales

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APPENDIX 2: Current Strategy timescales

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